Contrast-Enhanced Ultrasound in the Follow-Up of Endoleaks after Endovascular Aortic Repair (EVAR)

Abstract

Endovascular aortic repair (EVAR) has become established in the treatment of abdominal aortic aneurysms and shows potential benefits such as a low perioperative morbidity and a short hospitalization duration. The follow-up after EVAR primarily consists of lifelong postinterventional imaging of the aneurysm size in order to detect complications such as endoleaks or stent dislocation. Computed tomography angiography, an imaging modality that uses ionizing radiation and that relies on a contrast medium which is dependent on thyroid and renal function, is widely used for follow-up. Meanwhile, contrast-enhanced ultrasound (CEUS) has been established as a viable, fast and cost-effective imaging alternative for the follow-up and the detection of endoleaks after EVAR with the additional benefit of being a real-time non-ionizing radiation examination and having comparable or even superior diagnostic performance. This review describes the use of CEUS for follow-up after EVAR and describes the most common pathologies.

Zusammenfassung

Die endovaskuläre Aortenreparatur (EVAR) hat sich in der Versorgung von abdominellen Aortenaneurysma etabliert und zeigt als Vorteile eine niedrige perioperative Morbidität und Mortalität sowie kürzere Zeiten des Krankenhausaufenthaltes. Im Follow-up sind regelmäßige, letztlich lebenslange Kontrolluntersuchungen mittels Bildgebung erforderlich, um die Größe des Aneurysmasacks im Verlauf zu überwachen und zudem postinterventionelle Komplikationen wie Endoleaks oder Stentgraft-Migration und -Brüche zu detektieren. Weit verbreitetet zeigt sich die kontrastmittelverstärkte Computertomografie-Angiografie (CT-A) als Bildgebung nach EVAR, diese Methode beinhaltet jedoch die Anwendung von ionisierender Strahlung und jodhaltigem Kontrastmittel, welches abhängig von Nierenfunktion und Schilddrüsenstoffwechsellage nicht uneingeschränkt genutzt werden kann. Zwischenzeitlich hat sich der Kontrastverstärkte Ultraschall (CEUS) als leistungsfähige und kosteneffektive Schnittbildgebungsalternative für Follow-up-Untersuchungen nach EVAR etabliert mit den Vorteilen einer dynamischen Untersuchung und ohne Risiko für eine Nierenfunktionseinschränkung oder Strahlenbelastung. Hierbei zeigt sich der kontrastverstärkte Ultraschall ebenbürtig in der Detektionsrate und der Charakterisierung von Endoleaks im Vergleich zur CT-A. In diesem Review geben wir eine Übersicht über die Anwendung von CEUS in Rahmen des Follow-up nach EVAR und erläutern die Detektion und Charakterisierung der wichtigsten Pathologien.

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